Vascular access and cardiac disease: is there a relationship?

Despite advances in hemodialysis technology, a stable and well functioning vascular access remains the bane of every hemodialysis patient. It is recognized that vascular access contributes to cardiovascular disease mortality through a number of mechanisms. This review describes the relationship between vascular access and cardiovascular disease by reviewing the relationships between infection risk, inflammation and cardiovascular disease, and the cardiovascular changes that occur as a consequence of vascular access. Improved understanding of these mechanisms and their interrelationship is warranted.

The impact of arteriovenous fistula creation on cardiac structural and hemodynamic changes is described, as is vascular remodelling, which occurs in response to alterations in blood-flow properties. The development of central and peripheral vein stenosis is also a type of vascular remodelling and consequences of such events are not yet well understood. In addition, the contribution of vascular access to increased inflammation and atherosclerotic disease is reviewed. Finally, the hypothesis that vascular access dysfunction may be a predictor of vascular disease is explored.

The relationship between vascular access and cardiac disease exists at different levels, ranging from inflammation promoting atherosclerotic disease to vascular remodelling changes of stenosis formation and left ventricular hypertrophy. Countless research opportunities abound.